[Comparison of the Results of the Flicker Perimetry (Prototype versus Commercial Perimeter)]. / Vergleich der Ergebnisse der Flimmerperimetrie (Prototyp versus kommerziellem Perimeter).

Background: Analysis of the comparison of flicker perimetry with the prototype Pulsar and the new Octopus 600. Methods: Both eyes of 20 patients with primary open-angle glaucoma were studied with 30° visual field flimmer perimetry (dynamic strategy) at the perimeters Pulsar and Octopus 600 (Haag-Streit). The evaluation was based on the mean defect (MD = mean deviation) and the defect depth (square root of lost variance = sLV). Results: In the t test for paired samples, the Pulsar perimetry showed significantly higher values than the Octopus 600 perimetry: right eye MD 4.8 ± 3.6 src vs. 1.7 ± 2.9 src, p = 0.005; left eye MD 3.9 ± 3.6 src v. 1.4 ± 2.8 src, p = 0.018; both eyes MD 4.35 ± 3.62 src vs. 1.55 ± 2.80 src, p = 0.002. The sLV values with the Pulsar perimetry were significantly higher than the values with the Octopus 600 perimetry: right eye sLV 3.6 ± 1.6 vs. 2.3 ± 1.3 src, p = 0.006; left eye sLV 3.2 ± 0.8 vs. 2.0 ± 0.8 src, p < 0.0001; both eyes sLV 3.37 ± 1.28 src vs. 2.12 ± 1.05 src, p < 0.0001. The significances even persisted after the Bonferroni-Holm correction. Conclusion: The investigation results of flicker perimetry are not comparable, because there is a significant difference in MD and sLV. This mainly due to different light intensities, background brightness and varying colour scalings of the perimetric device.

[Aids for Patients with Glaucoma and Visual Impairment]. / Hilfsmittel für Patienten mit Glaukom und Sehbehinderung.

This article provides a broad overview of the existing medical aids and appliances for patients suffering from glaucoma and/or visual impairment. Furthermore, instructions for proper handling of eye drop therapy are given. There are many different public services to support patients with visual impairment and that aim to restore their mobility and autonomy in daily life. About 20,000 medical aids and tools are currently listed as refundable by insurances. The available supply ranges from magnifying reading aids to electronic aids and appliances to train patients' orientation, mobility and skills of every day life. Qualified professionals may be employed by organisations such as the DBSV e. V. and can accompany, support and counsel patients and their families with their specialised knowledge.

[Ambulatory 24-h blood pressure measurement in patients with glaucoma]. / Bedeutung des 24-Stunden-Blutdruckprofils beim Glaukom.

The arterial blood pressure is an important determinant for the development and progression of glaucoma. Some relevant information can be obtained only by ambulatory 24-h blood pressure measurement (ABPM). White-coat hypertension can be excluded by ABDM and the variability of blood pressure during 24 hours can be assessed. 24-h mean blood pressure should be < 130/80 mmHg. In contrast, diastolic blood pressure values below 60 mmHg during the night have been identified as a progression factor in glaucoma, as well as reductions of night-time systolic blood pressure of less than 10 % (non-dipper) and of more than 20 % (extreme dipper). The significance of the 24-h blood pressure profile for the cooperation of ophthalmology and internal medicine is discussed.

[Ocular blood flow regulation in glaucoma - examination with the ocular pressure flow analyzer (OPFA)]. / Okuläre Durchblutungsregulation beim Glaukom. Untersuchungen mit dem Ocular Pressure Flow Analyzer (OPFA).

BACKGROUND: The results of studies of ocular blood flow (BF) regulation of patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and ocular hypertension (OH) are presented. METHODS AND PATIENTS: Examinations were carried out with the "OPFA", a newly developed ocular pressure flow analyzer (producer: tpm Lüneburg) on 92 patients with newly diagnosed glaucomas, among whom 48 patients had POAG, 22 NTG and 22 OH, and compared with age-matched groups of healthy subjects. The OPFA uses pneumatic coupling through special scleral suction cups to record ocular pulses with highly sensitive transducers and a suction pump for simultaneously increasing intraocular pressure (IOP). Following local drop anaesthesia on both eyes, IOP is artificially raised to suprasystolic values. While continuously lowering IOP, the ocular pulse is then recorded with increasing ocular perfusion pressure. We obtain the relative ocular pulse blood volume by correlating the ocular pulse amplitudes with a calibration volume of 1 µl. This enables us to collect reproducible data on intra- and inter-individual pulse blood volume (PVoc). The ocular perfusion pressure pulse blood volume curve characterizes the respective individual ocular circulation as well as systolic and diastolic ocular perfusion pressures. RESULTS: In healthy subjects, the ocular pulse blood volume remains stable over a certain range of ocular perfusion pressure (ppoc) changes. After exceeding a critical point (CP), the ocular pulse blood volume drops. We refer to the difference between the CP and IOP as the autoregulatory capacity (AC). In patients with POAG and in patients with NTG, the AC was reduced significantly compared with the groups of healthy subjects. The mean AC of patients with OH remained within the normal range. The ROC curves showed at an optimal cut-off value for POAG a sensitivity of 75.0 % and a specificity of 97.9 %, for NTG a sensitivity of 77.3 % and a specificity of 100 %. In patients with POAG and OH, the ocular arterial pressures were elevated. In patients with NTG they remained unchanged compared with the healthy subjects. The ocular perfusion pressures did not change in POAG as well as in NTG and OH. CONCLUSIONS: In patients with POAG and in patients with NTG the ocular BF regulation was impaired and detected by the OPFA device with a high level of reliability. Ocular arterial blood pressures were increased as a result of vascular regulation to keep up the ocular perfusion pressure and to maintain ocular perfusion.

[Neurological disorders and glaucoma - an overview]. / Neurologische Erkrankungen und Glaukom - ein Überblick.

Due to the anatomic location of the N. opticus to the brain and its embryological development as a "bulging part of the brain", a close connection between the opticoneuropathy and certain neurological diseases exists. Glaucoma is a chronic neurodegenerative disorder and many cellular and molecular mechanisms of the chronic neurodegenerative diseases are common in the brain. For example, elevated levels of multiple biomarkers of Alzheimer's disease were found in the aqueous humor of patients with primary open-angle glaucoma. Also a decreased cerebrospinal fluid pressure (CSFP) has been demonstrated in patients with glaucoma and Alzheimer's disease. The resulting translaminar pressure difference is seen as one of the pathogenic mechanisms of the formation of the optic neuropathy in both diseases. Other hypotheses, such as the influence of oxidative stress, excitotoxicity, mitochondrial dysfunction, genetic factors and vascular factors play additional roles in the pathogenesis of the different diseases. Experimental studies have shown that dopaminergic amacrine cells are present in the retina. The dopamine in the retina is necessary for the light adaptation and the signal processing in the rods and cones. Parkinson's disease is characterised by a loss of dopaminergic neurons in the basal ganglia-substantia nigra pars compacta of the midbrain. These decreased levels of dopamine also have an effect on the eye and the afferent signal processing. So there are reductions in visual acuity, disturbances in colour vision and contrast sensitivity and reduction of the retinal nerve fiber layer in patients affected with Parkinson's disease. With the examples of Alzheimer's disease, Parkinson's disease and the chronic inflammatory disease multiple sclerosis, we demonstrate the association between the neurological diseases and the opticoneuropathy in primary open-angle glaucoma.

[Relevance of arterial hypertension in primary open-angle glaucoma]. / Die Bedeutung der arteriellen Hypertonie für das primäre Offenwinkelglaukom.

Primary open-angle glaucoma is a multifactorial disease with a lot of different risk factors. Beside the fact that intraocular pressure (IOP) is the most important risk factor, the reduction of IOP alone is in most cases not sufficient to stop the progression of glaucoma. Therefore, other risk factors play also an important role. One of them is arterial hypertension, the most common systemic disease in glaucoma patients. Arterial hypertension increases IOP slightly, but has an important negative effect on ocular perfusion. Especially the endothelial dysfunction with a disturbed retinal autoregulation plays an important role. Therefore, ischaemic and reperfusion effects alter the optic nerve head and have negative input to the glaucomatous optic neuropathy. In future glaucoma patients should be monitored by ophthalmologists as well as by general physicians/cardiologists to optimise their treatment and to stabilise their glaucoma as well as possible.

[Corneal endothelial cell density and its correlation with the severity of pseudoexfoliation]. / Hornhautendothelzelldichte in Abhängigkeit vom Schweregrad der Pseudoexfoliation.

INTRODUCTION: Pseudoexfoliation (PEX) syndrome is a common, age-related disease which is associated with the multifocal deposition of fibrillar PEX material in intra- and extraocular tissues. Subsequently among others second chronic open-angle glaucoma and corneal endothelial cell loss occurs. The present study analysed whether there is a correlation between the stage of the PEX process and corneal endothelial cell density (cECD), regardless of the non-existence or proof of secondary glaucoma. MATERIALS AND METHODS: One eye of 109 Caucasian subjects (mean age 71.7 years) was examined by slit-lamp microscopy and classified based on visible PEX deposits on the lens (mild and severe) and presence of glaucoma in 4 study groups. The control groups were healthy subjects and patients with primary open angle glaucoma (POAG). The cECD was measured with the endothelial cell mirror microscope (SeaEagle). RESULTS: All study groups and the POAG group showed a significant cECD reduction compared to the healthy control group: POAG: 6.0 %; PEX syndrome: mild 5.5 % and severe 11.0 %, PEX glaucoma: mild 7.7 % and severe 12.3 %. Further the cECD was significantly lower compared to the POAG group in severe PEX syndrome by 5.4 % and in severe PEX glaucoma by 6.8 %. cECD significantly decreased with increasing PEX stage independently of the presence of glaucoma. These differences remained statistically significant after Bonferroni-Holm correction. The analysis of the entire group of test subjects showed only a weak correlation between mean intraocular pressure and mean cECD. CONCLUSION: The results of this study showed a decreasing cECD with increasing PEX stage, regardless of whether glaucoma is present or not. The influence of the PEX process appears to be more pronounced than the influence of intraocular pressure.

[Pleiotropic effects in local drug treatment for glaucoma]. / Pleiotrope Effekte in der lokalen medikamentösen Glaukomtherapie.

In glaucoma treatment, beside the traditional reduction of intraocular pressure, additional therapeutic strategies have come into consideration. Therefore pleiotropic effects of medications, defined as positively acting effects independent of the main mechanism of action, represent a new research sub-field in medical therapy and play an increasingly important role in internal medicine. Using the example of local beta-blockers, alpha-2-agonists, carbonic anhydrase inhibitors and prostaglandin analogues, their pleiotropic spectra will be shown and discussed.

[Immunoassay for matrix metalloproteinase-9 in the tear film of patients with pseudoexfoliation syndrome - a pilot study]. / Immunoassay für Matrix-Metalloproteinase-9 in der Tränenflüssigkeit bei Patienten mit Pseudoexfoliationssyndrom - eine Pilotstudie.

INTRODUCTION: Matrix-metalloproteinases (MMPs) are proteolytic enzymes released by irritated epithelial cells of the ocular surface. It has been established that the subtype MMP-9 can serve as an inflammatory marker within the tear film. MMP-9 is also attributed to have an effect on the PEX-glaucoma development. Recently, a rapid immunoassay for detection of MMP-9 in the tear film was developed to estimate inflammatory extent during dry eye disease. The aim of this study was to analyse the MMP-9 concentration in tear film in PEX-syndrome. In addition, an assessment of the feasibility, reliability and readability of the test was done. METHODS: We randomly selected 10 patients with PEX-syndrome and 10 healthy control patients and measured tear film MMP-9 of one eye with the RPS InflammaDry Detector™ (Rapid Pathogen Screening Inc., USA). RESULTS: We detected increased levels of MMP-9 in tear film in PEX-syndrome. 80 % of the PEX-patients and 20 % of the controls showed a positive test result (>or= 40 ng/mL MMP-9) indicating a test specificity and sensitivity of 80 %. This corresponds approximately to the published values for the dry eye (sensitivity 87 %, specificity: 92 %). The performance of the test is simple. The patients tolerated the inclusion of the test strips well. However, it is difficult to estimate whether enough tear film was used and in many cases, the intensity of the "indicator line" was weak. CONCLUSION: The rapid MMP-9-immunoassay is a novel, meaningful approach for the detection of inflammatory activity of the ocular surface. We have shown an up-regulation of the non-specific inflammatory marker MMP-9 in tear film in PEX-syndrome and suggest an association with a tear film disorder. However, an improvement in the estimation of the amount of collected tears and readability is desirable.

[Risk factors in the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients]. / Einflussfaktoren auf die Ergebnisse des Farbpigmentprobentests Roth 28-hue (E) desaturiert bei Glaukompatienten.

BACKGROUND: Glaucoma is an ocular disease with typical progressive damage of the optic nerve. In the past it was postulated that glaucoma induces acquired colour vision disorders. Until now all studies about glaucoma and colour vision disorders did not include vascular risk factors. In the present study we determined several vascular risk factors concerning the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients. PATIENTS AND METHODS: On the basis of an analysis of variance (ANOVA) we determined the influence of several risk factors, such as arteriosclerotic and vasospastic risk factors, on the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients. 353 glaucoma patients were included in this study. RESULTS: We detected a strong influence of age and mean defect in perimetry and an additional effect of arteriosclerotic and vasospastic risk factors on the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients. CONCLUSIONS: We suspect that arteriosclerotic and vasospastic risk factors independently to glaucoma have an influence on colour vision. In the future attention additionally has to be given to vascular risk factors in the colour vision testing of glaucoma patients.

[Relationship between structure and function - what is first affected in glaucomatous disease and its progression and what implications can be drawn for glaucoma diagnostic procedures?]. / Wie läuft die Entstehung und Progression eines Optikusschadens bei einem primären Offenwinkelglaukom ab und welche Bedeutung haben diese Erkenntnisse für die Glaukomdiagnostik?

The development of a glaucomatous optic neuropathy is a long-lasting process in which retinal ganglion cells do not die spontaneously. Therefore to detect early changes in this process, functional tests should be done to first detect those changes that imaging technologies miss because the latter methods can only detect changes when retinal ganglion cells have already died and a consecutive loss of retinal nerve fibres has occurred.

[Therapeutic strategies in dry eye disease--a survey of possible substitution therapies and causal therapeutic approaches]. / Therapiestrategien beim trockenen auge--eine übersicht über mögliche substitutionstherapien und kausaltherapeutische ansätze.

Substitution therapy with artificial tears is the standard in dry eye disease. Nowadays there are a vast variety of different preparations. This article gives an overview of both new and old approaches to substitution therapy (one-, two- and three-phase preparations) as well as opportunities for the causal treatment. Here, we provide dry eye treatment options regarding sophisticated disease subgroups, classifications concerning the affected tear film layer (aqueous, mucinous or lipid phase), and immunological dysfunctions.

Memantine in moderate to severe Alzheimer's disease: an observational post-marketing study.

Memantine is an N-methyl-D: -aspartate (NMDA) receptor antagonist, approved for the treatment of moderate to severe Alzheimer's disease (AD). We conducted a 4-month observational, post-marketing, Austrian study of memantine in 377 outpatients with moderate to severe AD. In this 'real-life' setting, memantine was well-tolerated, and produced benefits in cognition (Mini-Mental State Examination), activities of daily living (Activities of Daily Living score), and global function (Clinical Global Impression scale). Treatment effects were apparent in both pre-treated and treatment-naïve patient subgroups.

[Physiology of aqueous humor formation, diurnal fluctuation of intraocular pressure and its significance for glaucoma]. / Physiologie der Kammerwasserproduktion sowie der Tagesdruckschwankungen und deren Bedeutung für das Glaukom.

In the human eye there is a balance between production of aqueous humor as well as its drainage. The intraocular pressure is held through different mechanisms in a stable balance. The aqueous humor is secreted by the ciliary epithelium lining the ciliary processes. Three physiological processes contribute to the formation and chemical composition of the aqueous humor: diffusion (5 %), ultrafiltration (15 %) and active secretion (80 %). The normal intraocular pressure amounts to 15 ± 3 mmHg, the normal diurnal fluctuation 5 mmHg. Aqueous humor leaves the eye by passive bulk flow via two pathways: the trabecular route and the uveoscleral route. In glaucoma patients this balance is disturbed resulting in individual high intraocular pressure or, respectively, high diurnal fluctuations. This leads to loss of retinal ganglion cells and visual field loss. As a recommendation for glaucoma patients it is useful to construct diurnal intraocular pressure curves to evaluate the "type of pressure" and to determine the diurnal fluctuations or, respectively, the time of the pressure maxima. With this knowledge, treatment of glaucoma patients can be managed in a more individualised manner and it seems to slow down the progress of the disease better than by merely reducing the intraocular pressure.

[Rho kinase inhibitors as new local therapy option in primary open angle glaucoma]. / Rho-Kinase-Hemmer als neue lokale Therapieoption beim primären Offenwinkelglaukom.

BACKGROUND: In 2014 in Japan and 2017 in the USA, the Rho-kinase inhibitors were approved as a new antiglaucomatous substance group and will now be launched in Europe. OBJECTIVE: On this occasion the current state of knowledge on Rho-kinase inhibitors is presented. METHODS: In intensive search in PubMed the relevant experimental and clinical literature on the Rho-kinase inhibitors ripasudil and netarsudil and the combination of netarsudil and latanoprost were selected and compiled for this review. RESULTS: The intraocular pressure lowering efficacy of ripasudil and netarsudil is in the range of the beta blocker timolol and the prostaglandin analogue latanoprost. In the fixed combination netarsudil/latanoprost the intraocular pressure reduction is greater than that of the single components and reaches a target pressure of below 15 mm Hg in 32%. Conjunctival hyperemia with 53-65% is the most common local side effect. Systemic side effects are very rare and so far there are no contraindications. CONCLUSION: The Rho-kinase inhibitors are an interesting new introduction for glaucoma therapy, as each new pressure-lowering therapy represents an additional chance to reach the individually defined target pressure level in a glaucoma patient with local therapy; however, many of the pleiotropic effects associated with Rho-kinase inhibitors have so far only been found experimentally and will require clinical confirmation in the future.

[Preoperative management of subconjunctival/sub-Tenon's glaucoma surgery with special consideration of the gel implant (XEN®)]. / Präoperatives Management bei subkonjunktivalen/subtenonalen glaukomchirurgischen Operationen unter besonderer Berücksichtigung des Gelimplantats (XEN®).

BACKGROUND: When using subconjunctival/sub-Tenon's ab interno glaucoma surgical procedures, patient selection and preoperative management are essential to reduce postoperative scarring of the bleb. OBJECTIVE: The aim of this study was to compile a list of risk factors that may have an unfavorable effect on the scarring process. METHOD: A literature search was carried out in PubMed with respect to the scarring process of the gel implant XEN®. RESULTS: Ophthalmological risk factors for conjunctivoscleral/Tenon's wound healing process include dry eye, allergies, use of eye drops containing preservatives and previous eye surgery. CONCLUSION: The preoperative administration of artificial tear substitutes, corticosteroids and the fundamental change to preservative-free eye drops can support the normalization of a chronic inflammatory altered conjunctiva and thus positively influence the wound healing process after surgery.

[Importance of the nuclear factor kappaB for the primary open angle glaucoma--a hypothesis]. / Bedeutung des nukleären Faktors kappaB für das primäre Offenwinkelglaukom--eine Hypothese.

The primary open-angle glaucoma (POAG) is an optic neuropathy which is influenced by a number of different risk factors. Some of them can induce the transcriptional factor NF-kappaB, a nuclear protein which binds to specific areas of the DNA to stimulate different genes. NF-kappaB can be activated by increased intraocular pressure, increased age, vascular diseases and by oxidative stress. In the case of POAG NF-kappaB might be overstimulated with the induction of uncontrolled biochemical reactions. Treatment strategies for reducing NF-kappaB are to reduce intraocular pressure as well as therapies with statins, omega-3-fatty acids and alpha-lipoic acid. This model is a hypothesis and is intended to provide a basis for further discussions and basic research.

[Analysis of antibody profiles against retinal antigens in serum from patients with glaucoma through mass spectrometry].

OBJECTIVE: To compare the difference of the antibody profile between the primary open angle glaucoma (POAG) and the healthy controls (CTRL). METHODS: It was a case-control study. Sera from 44 POAG and 48 CTRL were added to tubes containing pre-washed Protein G beads, which can capture IgGs. These IgG-Protein G-complexes were used to capture target antigens (homogenized bovine retina). After elution, the antigenic proteins were measured through surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. By t-test and multivariate statistical analysis, the spectra, the age and the gender between the two groups were compared; subsequently, the antigenic mass spectra data combined with the type of protein chips and the energy of laser desorption/ionization between these two groups were also compared, which indirectly reflect the antibody profiles of these two groups. RESULTS: The mean intensity of spectra were 4244.427 +/- 4721.115 in CTRL and 4049.864 +/- 4083.819 in POAG, which showed statistical difference (F = 1.340, P < 0.01); complex antibody profiles were found in both groups. Significantly different immunoreactive spectra were detected between POAG patients and control subjects. Some up-, but mainly down-regulated immunoreactivities were present in POAG patients. CONCLUSIONS: A significant different pattern of antibody profile is present between the POAG and CTRL. Down-regulated immunoreactivities present in POAG might mean an association between the "aberrant autoimmunity" and the primary open angle glaucoma.